MEDICARE: GAMMOH PREMIER VISION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	716	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528304458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAMMOH PREMIER VISION LLC

Provider Business Mailing Address
First Line	:	556 N EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3453
Country	:	US
Telephone Number	:	702-388-9400
Fax Number	:	702-385-1116

Provider Business Practice Location Address
First Line	:	556 N EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3453
Country	:	US
Telephone Number	:	702-840-2020
Fax Number	:	702-385-1116

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. NATALY GAMMOH
Credential	:	OD
Telephone Number	:	702-624-3002

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	09/17/2025

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